Religion, medicine, and conscience

MARY REICHARD, HOST: Today is Tuesday, May 6th.

Glad you’ve turned to WORLD Radio to help start your day. Good morning. I’m Mary Reichard.

NICK EICHER, HOST: And I’m Nick Eicher.

Coming next on The World and Everything in It: medicine, conscience, and one doctor’s stand.

Conscience protections for doctors have existed for decades. But they only work when enforced.

REICHARD: Under the Biden administration, that didn’t happen. Scott Armistead found out the hard way. WORLD’s Addie Offereins spoke with Dr. Armistead and Anna Johansen Brown brings you his story:

SOUND: [URDU GREETINGS]

ANNA JOHANSEN BROWN: It’s a mild spring day in Richmond, Virginia. Perfect for a game of pickleball. Scott Armistead and a group of four refugee men from Afghanistan meet regularly to play … and talk.

SOUND: [URDU CONVERSATION]

Armistead speaks Urdu fluently. He picked it up on the mission field.

SCOTT ARMISTEAD: When I was in undergrad, I felt called to become a medical missionary, missionary doctor. We ended up going to Pakistan, and were there for 16 years, from 1999 to 2015.

During that time, he gained a lot of experience helping Muslim patients. When he returned to the United States, Armistead took a job teaching second year medical students at Virginia Commonwealth University School of Medicine. The school’s family medicine clinic serves low-income patients. Many of them are immigrants and refugees.

Armistead was doing what he loved: teaching medical students and befriending muslim refugees. But he soon realized the U.S. medical field had changed while he was away.

ARMISTEAD: The ideological shift was moving from understanding the patient as an integrated whole to sort of dividing the patient so that the center of the person moved more to the mind and the feelings and the affections than it did to the body.

The way society understood the role of the American physician had also changed.

ARMISTEAD: The language of professionalism had sort of disappeared and the language of ‘provider’ had taken center stage. A professional is someone who has something to profess, something that they actually believe to be good and true. And a provider could be somebody who's just providing a service, almost like a vending machine or somebody giving you a latte at the coffee shop.

That perspective had already crept into Virginia Commonwealth University School of Medicine. Armistead found the new academic medical environment eerily similar to living under blasphemy laws in Pakistan.

ARMISTEAD: Certain conversations are not had, certain things are not questioned. But it was particularly odd because there was all of this talk about diversity and inclusion.

The changes started subtly. In 2019, clinic administrators introduced a new intake form that asked patients to describe their sexual practices in detail and included specific questions about transgender forms of intimacy—all before the patient's first visit.

Armistead knew that would not go over well with the many conservative, Muslim refugees who visited the clinic.

ARMISTEAD: To put it on a general intake form represented a certain understanding. That was just very inappropriate for very conservative cultures.

Shortly after, a group of students affiliated with the Christian Medical and Dental Associations approached Armistead with concerns about a new school policy.

ARMISTEAD: They were telling me that they were being told they needed to introduce themselves with their preferred pronouns and ask the preferred pronouns of the patient.

Armistead approached administrators with another coworker and together they argued the policy change wasn’t culturally competent. That it disrespected the students’ convictions. Administrators told them individual teachers like Armistead could discuss the change with their students.

But one year later, the school declared the clinic transgender friendly.

ARMISTEAD: So what that meant was that we would start seeing patients and giving cross sex hormones and being referring to different departments for reconstructive surgeries, vaginoplasties and that kind of thing. I suggested to the medical director that we talk about it among ourselves, because of the ethical ramifications of doing that and knowing that not everybody was on the same page, not just me, but others. But I was told that there would be no discussion and that it was a priority of the department.

Eventually, the school also began docking the grades of students who failed to ask patients for their preferred pronouns.

It all came to a head for Armistead one day when he was introducing a new group of students to the clinic. As usual, Armistead encouraged the students to reflect on what using someone’s preferred pronouns reveals about our understanding of the body and medicine.

ARMISTEAD: That got me in trouble with a student, at least one student who went to HR and complained about that. A couple months later, I got called to a meeting with the head of the department, and with HR and with my immediate supervisor, and I got accused of harassment and discrimination.

Administrators banned Armistead from working with students for six months, though he could still see patients on his own. But Armistead got the feeling the school was looking for an excuse to get rid of him.

ARMISTEAD: My nurse came to me and she said, Dr. Armistead, I just need to tell you, they're watching you like a hawk. At the end of those six months, there was another meeting called, and I was accused of clinical near misses and sort of irreconcilable relationships among staff, and then I was let go.

Clinical near misses are medical errors that had the potential to cause harm but didn’t.

Armistead is hopeful that under the second Trump administration hospitals and medical schools may be more wary of violating the conscience rights of medical professionals. But he’s worried that without state level change, conscience protections will continue to be at the mercy of whoever occupies the White House and that doctors will continue to leave the field.

ARMISTEAD: It's a stressful time to be in medicine in the United States. Repeated violation of conscience is destructive and contributes to physician burnout.

That’s why Armistead is advocating for a Virginia bill called the Medical Ethics Defense Act. It would give medical workers more legal recourse when their rights are violated.

ARMISTEAD: It didn't make it through the subcommittee just recently. But we realized that these fights often take a long time, so I think the plan is to reintroduce it in the future. And I'm encouraged that in other states this has been passed, and my hope is that in Virginia it will be in the future as well.

He’s determined to keep fighting for other Christian doctors and the next generation who will soon take their place in the workforce.

SOUND: [STUDENT CONVERSATION]

Regular meetings with Christian medical students is a key part of that effort.

On Fridays, Armistead and a group of Christian students meet for a book club to discuss medical ethics. After a recent meeting, they continued that conversation in the car. They were on their way to help an Afghan family move furniture into their new home.

ARMISTEAD: If our system is forming physicians who are not encouraged to follow their convictions and to think deeply about their ethics and to think deeply about issues of virtue, then we are doing a disservice to the public good.

For WORLD, I’m Anna Johansen Brown, with reporting from Addie Offereins.

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